Quality and Assurance Officer - TPA Health Claims

Job Summary

We are seeking a detail-oriented and analytical Quality & Assurance officer to join our Health Claims Department. The role is responsible for performing claims audits (including OFR & CFR), handling complaints review and resolution, monitoring operational quality, and preparing management reports to ensure compliance, accuracy, efficiency, and continuous improvement in claims processing.

The position plays a key role in safeguarding service quality, regulatory compliance, and client satisfaction in a TPA environment.

Key Responsibilities

1. Claims quality audits (OFR / CFR)

• Perform OFR and CFR on processed claims.
• Audit claims files to ensure:
  • Compliance with procedures, SLAs, and internal policies
  • Accuracy of decisions, documentation, and calculations
  • Proper application of benefits, rules, and approvals
• Identify errors, deviations, root causes, and process weaknesses.
• Document audit findings and follow up on corrective actions.

2. Complaints review & resolution oversight

• Review customer complaints related to claims handling and service quality.
• Investigate cases to:
• Identify root causes
• Verify compliance with procedures and contracts
• Ensure fair and consistent resolution
• Track complaint trends and propose preventive actions and process improvements.

3. Quality monitoring & process improvement

• Monitor overall claims quality performance and adherence to KPIs and SLAs.
• Contribute to:
• Process improvement initiatives
• Update of procedures and quality standards
• Training needs identification based on audit findings
• Support continuous improvement culture within the claims operation.

4. Reporting & management information

• Prepare and deliver regular quality reports to management, including:
• Audit results (OFR, CFR)
• Error rates and trends
• Complaints analysis
• Root cause analysis and recommendations
• Present findings, insights, and improvement proposals in a clear and structured manner.

5. Compliance & governance support

• Support compliance with:
• Internal policies and procedures
• Client SLAs
• Regulatory and contractual requirements
• Participate in internal and external audits when required.

Qualifications & experience

• University degree in Business Administration, Finance, Health Management, or related field.
• Experience in one or more of the following is strongly preferred:
  • TPA or insurance claims operations
  • Quality assurance / quality control
  • Internal audit or operational audit
• Good understanding of:
  • Health insurance / medical claims processes
  • Claims workflows and service quality standards
• Experience with OFR, CFR, or similar audit frameworks is a strong advantage.

Skills & competencies

• Strong analytical and auditing skills.
• High attention to detail and accuracy.
• Ability to interpret procedures, contracts, and SLAs.
• Strong reporting and presentation skills.
• Good written and verbal communication in English and Greek.
• Objective, structured, and solution-oriented mindset.
• Good command of MS Excel and reporting tools.
• Ability to work independently and manage multiple tasks and deadlines.
• AI Skills: (Generative) Artificial Intelligence or GenAI or AI, Data Analysis, (Microsoft) Copilot, ChatGPT

91623 | Customer Services & Claims | Professional | Non-Executive | Allianz Partners | Full-Time | Permanent

Allianz Group is one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams and challenges, is what makes us a unique employer. Together we can build an environment where everyone feels empowered and has the confidence to explore, to grow and to shape a better future for our customers and the world around us. 

At Allianz, we stand for unity: we believe that a united world is a more prosperous world, and we are dedicated to consistently advocating for equal opportunities for all. And the foundation for this is our inclusive workplace, where people and performance both matter, and nurtures a culture grounded in integrity, fairness, inclusion and trust. 

We therefore welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, social class, disability or sexual orientation, or any other characteristics protected under applicable local laws and regulations. 

Great to have you on board. Let's care for tomorrow.